IFSO Update Position Statement on One Anastomosis Gastric Bypass (OAGB)

Luca, Maurizio De; Piatto, Giacomo; Merola, Giovanni; Himpens, Jacques; Chevallier, Jean‐Marc; Carbajo, Miguel-A; Mahawar, Kamal; Sartori, Alberto; Clemente, Nicola; Herrera, Miguel F.; Higa, Kelvin; Brown, Wendy; Shikora, Scott A.

doi:10.1007/s11695-021-05413-x

Cited by 68 publications

(43 citation statements)

References 122 publications

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“…Severe protein–energy malnutrition (PEM) is an uncommon complication following OAGB that rarely requires corrective surgery [ 9 ] like in other BMS [ 10 ]. There is no uniform definition in the bariatric literature for protein–energy malnutrition, its severity grading or threshold for revisional surgery.…”

Section: Introductionmentioning

confidence: 99%

Revisional Surgery of One Anastomosis Gastric Bypass for Severe Protein–Energy Malnutrition

et al. 2022

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Background: One anastomosis gastric bypass (OAGB) is safe and effective. Its strong malabsorptive component might cause severe protein–energy malnutrition (PEM), necessitating revisional surgery. We aimed to evaluate the safety and outcomes of OAGB revision for severe PEM. Methods: This was a single-center retrospective analysis of OAGB patients undergoing revision for severe PEM (2015–2021). Perioperative data and outcomes were retrieved. Results: Ten patients underwent revision for severe PEM. Our center’s incidence is 0.63% (9/1425 OAGB). All patients were symptomatic. Median (interquartile range) EWL and lowest albumin were 103.7% (range 57.6, 114) and 24 g/dL (range 19, 27), respectively, and 8/10 patients had significant micronutrient deficiencies. Before revision, nutritional optimization was undertaken. Median OAGB to revision interval was 18.4 months (range 15.7, 27.8). Median BPL length was 200 cm (range 177, 227). Reversal (n = 5), BPL shortening (n = 3), and conversion to Roux-en-Y gastric bypass (RYGB) (n = 2) were performed. One patient had anastomotic leak after BPL shortening. No death occurred. Median BMI and albumin increased from 22.4 kg/m2 (range 20.6, 30.3) and 35.5 g/dL (range 29.2, 41), respectively, at revision to 27.5 (range 22.2, 32.4) kg/m2 and 39.5 g/dL (range 37.2, 41.7), respectively, at follow-up (median 25.4 months, range 3.1, 45). Complete resolution occurs after conversion to RYGB or reversal to normal anatomy, but not after BPL shortening. Conclusions: Revisional surgery of OAGB for severe PEM is feasible and safe after nutritional optimization. Our results suggest that the type of revision may be an important factor for PEM resolution. Comparative studies are needed to define the role of each revisional option.

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Section: Introductionmentioning

confidence: 99%

Revisional Surgery of One Anastomosis Gastric Bypass for Severe Protein–Energy Malnutrition

et al. 2022

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“…It has been endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) as an effective weight loss surgical option. 3 Despite which, the procedure remains controversial due to concerns about gastric and oesophageal malignancy, late post-operative morbidity, and national societies not endorsing the procedure. 4 As a result of this controversy, the OAGB is performed less than the standard laparoscopic Roux-en-Y Gastric Bypass (RYGB) and the Laparoscopic Sleeve Gastrectomy (LSG).…”

Section: Introductionmentioning

confidence: 99%

“…12 In the IFSO literature review, OAGB was found to have an acceptable complication rate and promising outcomes for weight loss and management of type 2 diabetes. 3 In Australia, LSG is the most commonly performed bariatric procedure, accounting for 67.6% of all bariatric procedures in 2019/2020 (RYGB and OAGB accounted for 11.3% and 8.9% of procedures, respectively). 13 The number of LSG procedures performed has increased over the last 5 years largely due to its simplicity and reproducibility, and quality evidence supporting it as an excellent alternative to the RYGB.…”

Section: Introductionmentioning

confidence: 99%

“…The laparoscopic One Anastomosis Gastric Bypass (OAGB) is a weight loss procedure with quality evidence to support its use. It has been endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) as an effective weight loss surgical option 3 . Despite which, the procedure remains controversial due to concerns about gastric and oesophageal malignancy, late post‐operative morbidity, and national societies not endorsing the procedure 4 .…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta‐analysis including 124 456 patients compared OAGB to RYGB and concluded that OAGB was superior in terms of weight loss and diabetes remission ‐ other benefits of the OAGB over RYGB included technical simplicity with a shorter learning curve, shorter operating times, and ease of revision and reversal 12 . In the IFSO literature review, OAGB was found to have an acceptable complication rate and promising outcomes for weight loss and management of type 2 diabetes 3 …”

Section: Introductionmentioning

confidence: 99%

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Outcomes of 325 one anastomosis gastric bypass operations: an Australian case series

Gricks

Eldredge

Bessell

et al. 2022

ANZ Journal of Surgery

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Background: The One Anastomosis Gastric Bypass (OAGB) is a relatively novel procedure. Studies have demonstrated that it is at least as effective as other bariatric procedures but with fewer major complications and shorter operating time, yet OAGB is performed less partially due to a paucity of supportive evidence. We report the outcomes of a prospectively maintained database of patients undergoing laparoscopic OAGB. Methods: All OAGB procedures performed by two surgeons across two hospitals from 2016 to 2019 were recorded in a prospectively maintained database. Patients with at least 1 year of follow up were included in this study and missing data was obtained from patient records. The primary outcome was percentage excess weight loss (EWL). The secondary outcome was surgical complication rate. Results: Three hundred and twenty-five patients with a mean pre-operative body mass index of 43.3 kg/m 2 were included. The majority (85.2%) had a biliopancreatic limb length of 150 cm. The median EWL was 74.2% and 79.4% of patients achieved at least 50% EWL. There were no deaths, the overall re-operation rate was 4.9% and 1.9% of patients developed stomal ulcers. Seven patients went on to have a Roux-en-Y conversion predominantly for symptomatic reflux. Conclusion: OAGB leads to excellent weight loss and is at least as safe as more commonly performed procedures, it may be a suitable treatment for a greater number of patients than it is being offered to at present.

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Early safety outcomes of laparoscopic one anastomosis gastric bypass in patients with class III, IV, and V obesity

Sakran,

Raziel,

Hod

et al. 2024

World j. surg.

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BackgroundThe extremely obese patient deserves special consideration: significant comorbidities, technical difficulties, and increased postoperative morbidity and mortality are all expected in this patient population. The study compared early postoperative complications (≤30‐day) following one‐anastomosis gastric bypass (OAGB) morbidity in patients with morbid obesity class IV obesity, body mass index (BMI) ≥50–59.9 kg/m2, and class V obesity, BMI ≥60 patients.MethodsWe retrospectively reviewed perioperative OAGB outcomes in three BMI groups. Operative time, length of stay (LOS), and overall early postoperative complication rates were studied. Patient‐reported complications were ranked by Clavien–Dindo Classification (CDC).ResultsBetween January 2017–December 2021, consecutive patients with obesity class III (n = 2950), IV (n = 256), and V (n = 23) underwent OAGB. BMI groups were comparable in sex, age, and associated comorbidities. Mean operative time was significantly longer in the higher BMI groups: class III (66.5 ± 25.6 min), IV (70.5 ± 28.7 min), and V (80.0 ± 34.7 min), respectively (p = 0.018); no difference in LOS. In respective BMI classes, ≤30‐day complication rates were 3.2%, 3.5%, and 4.3% (p = 0.926). The respective number of patients with CDC grades of one to two were 45 (1.5%), 6 (2.3%), and 1 (4.3%), p = 0.500; and in grade ≥3a, 25 (0.8%), 1 (0.4%), 0 (0.0%), p = 0.669. There was 0.06% mortality (n = 2 in 3229), both in BMI class III.ConclusionsOAGB is a safe BS procedure in patients with class III, IV, and V obesity in the perioperative term with comparable ≤30‐day morbidity in the three BMI groups.

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IFSO Update Position Statement on One Anastomosis Gastric Bypass (OAGB)

Cited by 68 publications

References 122 publications

Revisional Surgery of One Anastomosis Gastric Bypass for Severe Protein–Energy Malnutrition

Revisional Surgery of One Anastomosis Gastric Bypass for Severe Protein–Energy Malnutrition

Outcomes of 325 one anastomosis gastric bypass operations: an Australian case series

Early safety outcomes of laparoscopic one anastomosis gastric bypass in patients with class III, IV, and V obesity

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